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Published ahead of print on March 4, 2005, doi:10.1164/rccm.200409-1258OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 1, July 2005, 118-122

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Submitted on September 22, 2004
Accepted on February 25, 2005

Atrial Overdrive Pacing in Sleep Apnea Patients with Implanted Pacemaker

Lars Luthje1, Christina Unterberg-Buchwald1, Dani Dajani1, Dirk Vollmann1, Gerd Hasenfuss1, and Stefan Andreas1*

1 Department of Cardiology and Pneumology, Georg-August-Universitat, Gottingen, Germany

* To whom correspondence should be addressed. E-mail: sandreas{at}med.uni-goettingen.de.

Rationale: Atrial overdrive pacing markedly improved sleep disordered breathing in a recent study. Objectives: Using a single blinded, randomized, crossover design, we aimed to reproduce these findings and investigate the possible underlying mechanisms. Methods: Twenty ambulatory patients with an implanted pacemaker or cardioverter defibrillator were studied by polysomnography on three consecutive nights in a randomized single-blind crossover study in which devices were programmed for nonpacing, or for overdrive pacing at 7 or 15 beats per minute faster than the mean nocturnal heart rate. Ventilation (Respitrace) and biomarkers (urinary norepinephrine excretion, aminoterminal portion of the precursor of brain natriuretic peptide (NT-proBNP)) were also evaluated. Measurements and Main Results: Neither the primary endpoint apnea-hypopnea index, nor the apnea index, oxygen desaturation, ventilation or biomarkers were affected by the nocturnal atrial overdrive pacing. A small, clinically insignificant rate-dependent reduction in the hypopnea index was evoked by pacing (non-pacing: 13.4 ± 1.4; pacing 7: 12.9 ± 1.4; pacing 15: 10.9 ± 1.0; p ANOVA < 0.01). Conclusions: The lack of effect on the apnea-hypopnea index means that atrial overdrive pacing is inappropriate for treating sleep disordered breathing.
Key words: sleep apnea, pacing, randomized trial




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